L4- Inequalities and inequities Flashcards
Social determinants of health
Are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.
In areas of most sickness and death:
GPS have more work, larger lists, less hospital support and inherit more clinically ineffective traditions of consultation than in the healthiest areas
Hospital doctors should heavier case loads with less staff and equipment, more obsolete buildings and suffer recurrent crises in bed availability
Inverse Care Law:
These trends can be summed up as the inverse care law: that the availability of good medical care tends to vary inversely with the need of the population served
how health is measured
Mortality and life expectancy
Self- report (e.g surveys)
Broad questions
Inequalities in health are not only related to socioeconomic factors- but also with diversity
Relationships between factors are complex
Health of each individual patient is related to socioeconomic status (and the constraints within which they live), ethnicity, gender and age
health and social class
Deprivation strongly associated with ill health: - The more deprived a person is the larger the proportion of their life will be spent in ill health and more likely to die at a younger age
Health and gender
‘Men die quicker, but women get sicker’
Men
Mean
- Lower life expectancy
- More CVD e.g. heart attacks
- More suicide
- More violent death
Women
- Higher life expectancy
- Higher reported (poor) mental health
Higher rates of disability and limiting longstanding illness
health and ethhnicity
- culture- ways of being/doing
- access to/ exclusion from sevreices/resources
- genetic factors
Explanations, theories and pathways for health inequalities (6)
- Artefact (discredited)
- Social selection
- Behavioural-cultural
- Materialist (most plausible)
- Psychosocial
- Income distribution
1.Artefact explanation
Health inequalities evident due to the way statistics are collected (re measurement of class)
Artefact explanation
-Concerns about quality of data and method of measurement: Numerator
based on occupational distribution of those who die during the period considered
Artefact explanation
-Concerns about quality of data and method of measurement: denominator
occupational distribution at the most recent cencus
Social selection explanation
- Sick individuals move down social hierarchy, healthy individuals move up
- Chronically ill and disabled more likely to be disadvantaged
- Plausible explanation
Behaviour-cultural explanation
Ill health due to peoples choices/ decisions, knowledge and goals.
limitations of behaviour- cultural explanation
- Behaviours are outcomes of social processes, not simply individual choice
- Choices may be difficult to exercise in adverse conditions
- Choices may be rational for those who lives are constrained by lack of resources
Materialist explanation
Lack of choice in exposure to hazards e.g. radiation
Accumulation of factors across life course
Most plausible
which explanation is most plausible
materialist explantion
limitations of materialist explanation
Limitations:
Further research needed as to precise routes through which material deprivation causes ill-health
Psychosocial explanation
- Health influenced more by differences in income than actual income
- Some stressors are distributed on a social gradients e.g. negative life events, social support, autonomy at work and job security
- Stress impacts on health via different pathways
Stress impacts on health via different pathways
Direct- physiological and immune system
Indirect- mental health
Income Distribition (Wilkinson)
- Relative (not average) income affects health
- Countries with greater income inequalities have greater health inequalities
- It is not the richest, but the most egalitarian societies that have the best health
Larger the income gaps within a country, the worst the country performs on these health and social problems.
WHY?
Psychosocial explanation
Redistributive policies: reducing income inequality in a society can improve social well-being and in in turn many other health and social factors
what can eb done to stop inequalities and inequities
- Strengthening individuals
- Strengthening communities
- Improving living and working conditions
- Promoting health macro policies
Inequity-
inequity refers to unfair, avoidable differences arising from poor governance, corruption or cultural exclusion
Inequality-
inequality simply refers to the uneven distribution of health or health resources as a result of genetic or other factors or the lack of resources
you can have inequality
without inequity
Inequities in Access to healthcare
More deprived groups seem to have:
Higher rates of use of
- GP services
- Emergency services
Under-use of
- Preventative services (screening, asthma, outpatients)
- Specialist services (cancer treatment)
Deprived peoples health is usually managed a
as series of crises (i.e. they don’t go to the doctor until they are very unwell)
Normalisation of ill-health
solution to deprivation and access
Event based counsellin
events based counselling
Event based counselling (i.e. at a food bank or walk in clinic at homeless shelters) may be needed to legitimise consultation
- These events are expensive- difficult marshalling resources needed for negotiation and engagement with health services.
- Due to lack of cultural alignment between health and service and lower socio-economic groups
name some social determinants of health and illness
Social class, ethnicity, gender and deprivation
Inequality and inequity in health and healthcare access are significant contributors
to (ill)health in Britain
